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levels of military medicine Flashcards

1
Q

self/buddy aid to battalion aid station

A

role 1

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2
Q

brigade or division, brigade support batallion; area medical support companies, forward surgical teams; 1st level w/ blood, limited x-ray and lab, patient hold capability

A

role 2

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3
Q

corps level- combat support hospital; in theater military treatment facilities; full surgical care, hold, lab, radiology to include CT; stabilizing care for evac

A

role 3

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4
Q

definitive care; out of theater; full rehab care; teriary care

A

role 4

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5
Q

hospitals in the us

A

role V

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6
Q

MC causes of spinal cord injury?

A
  1. vehicl
  2. falls
  3. violence
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7
Q

what is the MC injured part of the spine?

A

c-spine specifically c2 and c5-c7

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8
Q

what is the second MC site of injury to the spine?

A

thoracolumbar

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9
Q

how many pairs of spinal nerves and where? also where does the spinal cord terminate?

A

L1, L2

31 pairs

c=8
t=12
l=5
s=5
c=1
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10
Q

is injury to the thoracic spine common?

A

no, severe traumatic forces. also the canal is skinnier so injury to the cord increases

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11
Q

sacral fractures that involve the central sacral canal can produce?

A

bowel and bladder dysfunction

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12
Q

when is the spine considered unstable?

A

if two of the columns are involved (DENIS: anterior, middle, posterior

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13
Q

what should you assume about every spine fracture in the ED?

A

that they are unstable until expert consultation w/ spine surgeon

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14
Q

how will a complete neurologic spinal lesion present?

A

absence of sensory and motor function below the injury

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15
Q

what is spinal shock?

A

loss of all reflex activities below the area of the injury, so lesions can’t be determined as complete or incomplete until after

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16
Q

descending motor pathway that originates from the cerebral cortex and cross in lower medulla?

A

lateral corticospinal tract

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17
Q

injury to corticospinal tract results in?

A

ipsilateral muscle weakness, spasticity, INCREASED DTR and babinski sign

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18
Q

tract that enters dorsal grey horn where they immediately cross and ascend?

A

spinothalamic tract

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19
Q

spinothalmic tract injury will result in?

A

contralateral loss of pain and temperature sensation below the level of injury

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20
Q

tract that enter’s the spinal cord, but does not immediately decussate?

A

dorsal (posterior) column

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21
Q

dorsal column injury results in what?

A

ipsilateral loss of vibration and position sense

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22
Q

what injuries must be present for complete loss of light touch?

A

spinothalmic and dorsal columns

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23
Q

when is spinal immobilization no longer recommended?

A

fully conscious, neurologically intact patients w/ isolated penetrating neck injury

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24
Q

what symptoms can indicate present or impending respiratory compromise

A

dyspnea, palpitations, abdominal breathing, anxiety, high cervical spine injury

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25
Q

evaluation of cauda equina?

A

MRI

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26
Q

what happens if t1-t4 are compromised?

A

loss of sympathetic innervation of the hear bradycardia

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27
Q

what must you do w/ neurogenic shock?

A

rule out other causes of hypotension first

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28
Q

what can cause an imcomplete to mimic a complete?

A

spinal shock

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29
Q

what is nexus?

A 
Neurological focal deficit
ETOH
X distracting injuries
Unconsious/ AMS
Sore midline cervical tenderness
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30
Q

consious

A

GCS <15, not oriented oriented ppte, 3 things in 5 in, inability or delayed response to external stimuli

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31
Q

canadian cervical

A

no high risk factors
low risk factors that allow rom
patient able to rotate 45 degrees

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32
Q

thoracolumbar frx is at high risk for what?

A

aortic, intrathoracic or intra-abdominal

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33
Q

sacral fractures are associated w/ what?

A

frxs of the pelvis

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34
Q

what is mild/moderate/ and severe GCS?

A

14-15, 9-13, 3-8

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35
Q

what is the low limit for cerebral perfusion pressure?

A

<60 mmHg

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36
Q

what must your mean arterial pressure be above when you don’t have an ICP monitor?

A

80

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37
Q

what causes secondary brain injury?

A

massive release of release of neurotransmitters w/ activation of n-methyl-d-aspartate causes water to go into spaces and ends in cell death

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38
Q

two casues of brain edema?

A

cellular swelling (from ionic shifts)

extracellular edema (results from direct damage to or break down of the blood brain barrier)

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39
Q

what is the most common brain herniation?

A

uncal

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40
Q

patient presents w/ ipsilateral fixed and dilated pupil, this progresses to contralateral motor paralysis, what has occured?

A

uncal herniation, then pyramidal tract compression

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41
Q

patient presents w/ bilateral pinpoint pupils, bilateral babinski sign and increased muscle tone. This is followed by fixed midpoint pupils, prolonged hyperventilation, and decorticate posturing, dx?

A

central transtentorial herniation

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42
Q

patient presents w/ pinpoint pupils, flaccid paralysis, followed by sudden death?

A

cerebellotonsillar herniation

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43
Q

patient presents w/ conjugate downward gaze, abscence of vertical eye mvments and pinpoint pupils.

A

upward transtentorial herniation

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44
Q

motor score of gcs correlates w/ what?

A

outcome

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45
Q

epidural lesion looks like what?

A

football

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46
Q

what do you need to do before intubating?

A

preintubation GCS

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47
Q

where is a decorticate injury?

A

higher level of midbrain

48
Q

what to do for uncooperative combative patient?

A

intubate and sedate

49
Q

what does hyperventilation do?

A

cerebral vasoconstriction keep PCO2 35-45

50
Q

what suggests increased ICP?

A

bilateral fixed and dilated pupils, CT pathology, decerebate and decorticate posturing, change in mental status

51
Q

treatment for traumatic brain injury?

A

hypotension, hypoxemia, hypercarbia, hyperglycemia

52
Q

what are the induction and paralytic agents

A

etomidate + rocuronium

propofol + succinylcholine

53
Q

what do you need to have MAP and systolic BP above to prevent hypotension and secondary brain injury?

A

> 90 and >80

54
Q

what are signs of impending trantentorial herniation?

A

unilateral or bilateral pupillary dilation/ hemiparesis, motor posturing, neurologic deterioration, monitor w/ GCS and repeat CT

55
Q

what CPP must you maintain to adequately profuse the brain?

A

55-60

56
Q

what patient should you consider ICP monitoring in even if there brain CT is normal?

A

over 40, unilateral/bilateral motor posturing, systolic BP <90

57
Q

what is a bad ICP

A

> 20mm hg

58
Q

treatment for scalp laceration?

A

direct pressure, licaine w/ epi, clamp or ligate bleeding vessels

59
Q

what to do if skull fracture?

A

ct scan, explore them gently

60
Q

fractures that are open, depressed, involve a sinus or a re associated w/ pneumocephalus recieve waht?

A

vanc 1, ceftriaxone 2

61
Q

what is the MC basilar skull fracture?

A

petrous protion of the temp bone, external auditory canal, and the tympanic membrane

62
Q

patient presents w/ otorrhea or rhinorrhea secondary to?

A

dural tearing w/ basilar skull fracture

63
Q

what is CI in cribiform fracture?

A

NG tube

64
Q

patient spresents w/ CSF leak, mastoid ecchymosis (battle), periorbital eccymosies (racoon) hemotympanum, vertigo, decreased hearing or deafness/ seventh nerve palsy, + beta transferrin? dx. trx

A

basilar skull fracture

neurosurgeon, as about abx ceft 2, vanc 1

elevate head of bed

lumbar drain

65
Q

contusions are associated w/ what?

A

subarachnoid hemorrhage

66
Q

2 way contusions occur?

A

at site or contrecoup on the opposite side

67
Q

treatment for contusion?

A

serial CTs because they can take a while to show up especially if coaulopathy

68
Q

patient presents w/ HA, photophobia, meningeal signs, blood in CSF? dg. treatment

A

subarachnoid hemorrhage, performed 6-8 hrs post injury

69
Q

patient presents w/ hx of loss of consciousness, AMS followed by lucid period and subsequent rapid neurologic demise? dx

A

epidural if recognized early expect a full recovery, from high pressure arterial bleed

70
Q

subdural hematoma is from what?

A

sudden acceleration/decerlatoin that tears bridging dural veins

71
Q

who is more likely to get a subdural hematoma?

A

elderly, alcoholics and kids <2 y/o

72
Q

when does a subdural hematoma become chronic>

A

2 weeks

73
Q

what does a subdural hematoma look like on ct?

A

moon, might be easier to see on MRI or CT w/ contrast

74
Q

treatment for subdral hematoma?

A

surgery for acute and subacute, chronic may not need surgery

75
Q

treatment for gun shot wound to head?

A

intubation

abx: vancomycin + cefriaxone

76
Q

treatment for head stab wounds?

A

admit, abx, surgery to remove

77
Q

most frequently injured organ and most frequently injured in sports accident?

A

liver then spleen

78
Q

assume and penetrating injury to lower chest, pelvis, flank or back has what?

A

penetrated the abdominal cavity until proven otherwise

79
Q

young and healthy patients can do what w/ intra-abdominal injuries?

A

compensate for a long time

80
Q

pt presents w/ hx of direct blow to abdomen/sudden muscle contraction now has pain w/ flexion and roation and ttp. also has palpable mass inferior to the umbilicus. dx

A

abdominal wall injury, rectus abdominis hematoma

81
Q

what might be the only clue indicating blood loss from a solid organ injury?

A

increased pulse pressure

82
Q

what injuries refer to the shoulders?

A

liver and spleen

83
Q

what predisposes you to splenic injury?

A

pregnancy and mononucleosis

84
Q

hollow viscious injuries produce what kind of symptoms?

A

blood loss and periotoneal complaints from contamination by GI contents

85
Q

patient presents w/ hx or rapid deceleration they hit the steering column/ hitting handlebar?

A

pancreatic injury

86
Q

patient presents w/ ab pain distension and vomiting?

A

duodenal hematoma

87
Q

what is the primary diagnostic study for abdomen injuries?

A

FAST focused assessment w/ sonography for trauma

88
Q

what is so great abou the fast?

A

rapid identification of free intraperitoneal fluid in the hypotensive patient w/ blunt abdominal trauma

89
Q

where is a good place to see a hemoperitoneum?

A

morrison’s pouch

90
Q

what is the noninvasive gold standard for diagnois of an abdominal injury?

A

abdominopelivic CT w/ IV contrast

91
Q

what is the ideal study for duodenum and pancreas and can differentiate the amount and type of free fluid in the abdomen, and grade of injury?

A

CT w/ IV

92
Q

what is the gold standard therapy for patients w/ significant intra-abdominal injuries?

A

laparotomy: allows for complete evaluation of retroperitoneum and abdomen

93
Q

who needs lapartomy?

A

persistent hypotension, abdominal wall disruption, or peritonitis

94
Q

when should an abdominal patient return to the ER?

A

fever, vomiting, increased pain, symptoms of blood loss (dizzy, weak, fatigue)

95
Q

1 cuase of death 1-44 y/o and number 3 overall?

A

trauma

96
Q

what are the essential characteristics for a level 1 trauma center?

A

24 hr. availability in all subspecialities

24 hr. availability of neuroradiology and hemodialysis

program that establishes and monitors effect of injury prevention and education efforts

organized trauma research program

97
Q

what does ED care begin w/?

A

intial assessment for potential life serious injuries

98
Q

patient presents w/ absent breath sounds, initialy chest tube >1000ml/>200 ml indicating vas inj. or massive hemothorax?

A

thoracotomy/ video assisted thoracic surgery

99
Q

up to 30% of blood can be lost w/ only mild tachycardia and decresed?

A

pulse pressure

100
Q

if there is no improvement after adminstering 2L of crystalloid what to do?

A

transfuse type O (negative if woman of childbearing age)

101
Q

what to do w/ open pelvic fracutes?

A

wrap or sling

102
Q

what to do for patient recieving >10 prbcs?

A

give 1:1 prbc w/ FFP

103
Q

if GCS <15 assume what?

A

significant head trauma

104
Q

what can hypothermia cause?

A

bleeding and coagulopathy

105
Q

what should prompt immmediate transport to or for penetrating abdominal injury?

A

abdominal tenderness
distension
hypotension

106
Q

gunshot wound trx?

A

almost all get emergent exploratory larparotomy

107
Q

who should get a thoractomy?

A

penetrating chest trauma w/ witnessed signs of life during transport, or in the ED

108
Q

what is part of the secondary survey?

A

cant be started until after basic functions are corrrected

scalp lacerations
tympanic membrane
neck and thorax
facial trauma
urinary meatus
rectal
prostate
manual/speculum
109
Q

if meatal blood is present and the prostate is displaced what do you have to do?

A

perform RUG before instering cath

110
Q

what are the most frequently missed conditions?

A

orthopedic but also esophagus, diaphragm and small bowel

111
Q

when must a tertiary exam be completed

A

w/in first 24 hours

112
Q

what is required in gunshot wounds to the torso?

A

chest X-ray

113
Q

what can fast identify

A

intraperitoneal bleed, pericardial tamponade, pneumothorax, and hemothorax

114
Q

what are routine labs?

A

blood type and screen, hemoglobin level, urine dipstick testing for blood, ethanol level, hcg

115
Q

ams order what?

A

glucose

116
Q

> 55 consider what?

A

ecg and troponin

117
Q

what exams should you do before transporting a patients?

A

primary and secondary

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